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FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
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  From the desk of editor in chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR

 
  Editorial ...

10th December, 2010, Friday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Revisiting 2010: PPI may not cause birth defects when used early in pregnancy

A Danish paper in the New England Journal of Medicine indicates that omeprazole appear to be safe for pregnant women and women who may become pregnant. Researchers in Copenhagen looked at data on all infants born alive in Denmark between January 1996 and September 2008.

Proportion of babies with birth defects hovered at about 3% in both groups –– 3.4% of those who had been exposed to a PPI in utero, and 2.6% for unexposed babies. In an unexpected finding, there was a 39% increased risk of major birth defects among children whose mothers had taken PPIs in the month before conception, a finding the authors are attributing to either chance or to another factor, perhaps the reason the mother was taking the medication in the first place. This could have been infection with Helicobacter pylori.

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook
 
  Quote of the Day

(By Dr GM Singh)

"Love people, not things; use things, not people."

Spencer W. Kimball

 
    Photo Feature (from the HCFI Photo Gallery)

 Medico Masti – College and Youth Festival 2010

Students from different Colleges took part in the Pot designing competition in the 17th MTNL Perfect Health Mela this year.

 
Dr K K Aggarwal
 
    National News

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology

Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

Delhi High Court has stayed the action on Indian Medical Association office bearers by Medical Council of India.

MCI in its order dated 23rd November, 2010 removed the names of the present President and Secretary of IMA for six months on the grounds that IMA has violated the code of conduct for doctors and professional association of doctors in their relationship with pharmaceutical and allied health sector industry. As per MCI, IMA by entering into MOU with Pepsi for conduct of health awareness programme has violated clause 6.81 (h). The High Court gave a stay on the following points in an appeal filed by Dr. Dharam Prakash, Secretary, IMA:

  1. Any complaint to MCI has to be dealt with by the State Medical Council. It is only where the State Medical Council is unable to dispose of the said complaint within six months in terms of clause 8.7 of the IMC Regulation 2002 that complaint is transferred to MCI to be dealt by it directly. In this case the MCI has taken the investigation directly.
  2. a. That there is no provision under the IMC Regulations 2002 or the IMC Act for dealing with misconduct of an association of medical professionals in particular the manner in which the punishment should be awarded to an association after the finding is rendered that such association has committed professional misconduct.
    b. Chapter 8 of the IMC Regulation 2002 also does not provide that when an association is held to be guilty of professional misconduct, all the office bearers of such association or any one of them would be liable to undergo punishment that may be removed for a period of six months. Absence of a specific provision in the IMC Act provides that name cannot be removed by the MCI.
    c. Section 24 of IMC Act gives the power to remove a name from the Indian Medical Register only to the concerned State Medical Council with an appeal against such decision to the Central Government.
  3. MCI never gave to the petitioner a chance that in his capacity as secretary IMA, he is likely to face punishment for the professional misconduct by the IMA much less by removal of his name from the IMR for a period of six months. There was no occasion for the petitioner to defend himself against such action.

    Notices were issued to MCI and Ministry of Health and Family Welfare. The replies are supposed to be filed within four weeks and rejoinder to the same to be filed within two weeks thereafter. The court felt that the petitioner has made out a prima facie case for grant for an interim stay till next date of hearing. The order was given on 29th November, 2010 by Justice S. Muralidhar. The matter is again listed on 22nd February, 2011.

    After this order MCI issued show cause notices to office bearers of IMA on the same issue. The same also were stayed by Delhi High Court on 8th December, 2010.
 
    International News

(Contributed by Rajat Bhatnagar, International Sports & Fitness Distribution, LLC http://www.isfdistribution.com)

Exercise most important lifestyle choice for good health

A recent research review concluded that apart from not smoking, being physically active is the most powerful lifestyle choice any individual can make to improve their health. Physiotherapist and lecturer, Leslie Alford, from the University of East Anglia published a review of 40 papers covering the latest international research published between 2006 and 2010, in the International Journal of Clinical Practice. According to Alford, people who engage in regular exercise could reduce their risk of developing around two dozen physical and mental health conditions, and slow down how quickly their body deteriorates as they age. Benefits include reducing the risk of certain types of cancers, osteoporosis, type 2 diabetes and a possible decrease in this risk of dementia in the elderly.

(Dr Monica and Brahm Vasudev)

People with type 2 diabetes urged to exercise 150 minutes per week

  • People with type 2 diabetes should get 150 minutes of aerobic exercises a week, according to a new recommendation.
  • Diabetics not let more than two days pass between exercise (sessions) because frequent activity is key to keeping blood glucose levels from rising.
  • Combining physical activity and modest weight loss can lower the risk of developing type 2 diabetes by up to 58% in high–risk populations.

Medicolegal: Commercial drivers should stay off the road for a year after TIA or stroke

A panel of 3 experts advising the U.S. Department of Transportation conducted a systematic review on stroke and TIA survivors’ risk for recurrent attacks and motor vehicle crashes. They found strong evidence that people who have had a TIA are at increased risk for stroke. They found a 65–fold increased risk for stroke one month after TIA, which decreased to 16–fold at six months and 6–fold at one year. The panel concluded that patients who have suffered a TIA or minor stroke should not drive a commercial vehicle for at least one year, even if they are taking medication to prevent a stroke. After a year, individuals who want to drive commercially should undergo a thorough physical and mental evaluation by a neurologist or other physician knowledgeable on the topic. If the drivers pass the examination, they should be recertified on annual basis and any recurrence of stroke or TIA will result in permanent disqualification. The panel’s conclusions were published by Stroke on Oct. 28.

California team first to use "augmented reality" during kidney surgery

Surgeons at USC University Hospital in Los Angeles used augmented reality' during kidney surgery. The technique involves using a CT scan to create a three–dimensional image of the kidney, including locations of a tumor and blood vessels. During the procedure, the image is superimposed onto a live image of the kidney, allowing the doctors to identify where normally unseen structures are during the operation.

 
    IMA Update

Redefining IMA 2015

III. IMA Working

  1. Office day–to–day management: Executive secretary. Non Medical
  2. Apply e–Governance & Teleconferencing: Paperless office
  3. Meetings: Structured Business meetings CWC/CC etc. Agenda – Priority for current burning issues
    • Background information with Talking points
    • Discussion with prior intimation
    • Conclusion on every Agenda
  4. Coordinate with Govt
    NBE
    MCI
    NGOs & WHO
    Other NMAs
    CMA, WMA
  5. Website – Interactive and linked to State and Local Branches
 
    Infertility Update

Dr. Kaberi Banerjee, Director Precious Baby Foundation

What is artificial insemination with donor semen?

The alternative to ART for many couples, including those who fail ART, is artificial insemination with donor sperm. This time–tested method has a very high success rate in apparently normal female recipients: 50% pregnancy rate with six cycles of insemination. Children born from pregnancies resulting from donor insemination grow and develop normally, both physically and psychologically

For queries contact: banerjee.kaberi@gmail.com

 
    Medicine Update

Dr. Neelam Mohan, Director Pediatric Gastroenterology, Hepatology and Liver Transplantation, Medanta – The Medicity

Can lactose intolerance be dangerous?

No, except for less calcium and good protein intake, ingestion of lactose will cause only transient symptoms. There is no long term risk of developing cancer!

 
    Medicolegal Update

Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS

Doctor’s role must be ethical to help the rape victim during medical examination

A woman who has been raped often encounters painful and humiliating procedures when she reports her sexual assault even in hospital emergency room where she may wait a long time for a medical examination and the collection of evidence that is needed to convict a suspect. She often has little privacy while she waits. The offence of rape is a brutal crime not only against the human body; it also affects mind and soul of victim resulting in rape crisis syndrome. The Doctor who examines a rape victim in hospital should listen and act fast as counselor to release some of the emotions to make the victim feel calm and comfortable. A program called SANE (Sexual Assault Nurse Examiners) that has been established in Tulsa, Oklahoma and several other U.S. cities, seeks to treat the emotional, physical, and legal needs of rape victims with greater consideration and sensitivity.

  • A medical professional should test for STDs, including HIV/AIDS to start treatment courses for protection against developing these diseases.
  • Treatment to prevent an unwanted pregnancy,
  • A medical examination to check for any internal injury that might have been caused by the rape.
  • A medical professional or trained technician may look for and take samples of the rapist’s hair, skin, nails, or bodily fluids from victim clothes or body.
  • A doctor can test for a rape drug, if the victim thinks that she may have been given a rape drug, a doctor can test for this, too. Be aware that this toxicology test covers any and all illegal drugs.
  • At any time during the medical exam, the victim can say if you don’t want a certain test performed or evidence collected. All procedures are being done to help victim and can only be done by valid consent of victim.
  • Victims should be seen in private rooms that are decorated to avoid the look of a sterile, hospital waiting room.
  • The nurse examiner allows the victim to complete the examination at her own pace, in from one to five hours.
  • A police officer should be requested to be available to transport the evidence to laboratory for analysis.

Reference TC Carmody. 2002. "A Feminist Repudiation of the Rape Shield Laws." Drake Law Review 51 (October).

 
    Rabies Update

Dr. AK Gupta, APCRI, Author of "RABIES – the worst death"

A pregnant woman develops rabies. What should be done?

In case the mother develops rabies, the rabies virus is not known to cross placental barrier, and as a result, the fetus is safe. Hence, the rabies pregnant woman should be clinically managed and if induction of pregnancy or caesarean section is possible, the obstetrician should do it with some "personal precautions" and immunoprophylaxis (usually three doses of modern vaccine or if any accidental exposure is there, then full course of post–exposure vaccination either by IM or ID route should be given to the obstetrician.) Later the new born may be given full course of rabies PEP vaccination.

 
    Legal Question of the Day

(Contributed by Dr M C Gupta, Advocate)

Q: Can a chat message be the subject of litigation?

A: The exact answer will depend upon the specific situation.

Examples:

  1. If A reveals to B during a chat session that he/she is HIV positive and is going to marry C, then B would be justified in informing C about it. Here the chat would be used in litigation if A sues B for breach of confidentiality. The court is likely to exempt B because of the involved risk to C that B tried to prevent.
  2. If A performs surgery upon B after written consent and after a chat session with B wherein he explained to B the nature of surgery and the pros and cons of the same, and later B sues on the ground that informed consent was not taken, B is likely to lose.
  3. In general, communication from A to B, if proven, cannot be dismissed simply because it was transmitted during a chat session. As per the principles of the Indian Contract Act, 1872, there is nothing in the Act that precludes the possibility a contract or agreement being arrived at by means of chat.
  4. In June 2010, the US Supreme Court ruled in favor of an employer who read worker’s messages http:// cyberlaw.org.uk / 2010/ 06/ 18/ messaging–at–work–us–supreme–court–rules–in–favor–of–employer&ndwho-read-workers-messages/
  5. In or around April 2010, the Kent Police in UK had brought charges under the Obscene Publications Act 1959 (OPA), against an individual that related to online chat. http:// www.theregister.co.uk/ 2010/ 04/ 26/ obscene_publications_chat/
 
    Medilaw

Recall of informed consent is not affected by the timing of obtaining informed consent before endoscopic procedures

Evidence

Sixty patients scheduled for colonoscopy or esophagogastroduodenoscopy were enrolled in this prospective, randomized study. Each patient received informed consent 24 to 72 hours or immediately before the procedure, and follow–up occurred one to three days post procedure. There was no statistically significant difference in recall of informed consent or the individual elements of informed consent (indication, risks, benefits, alternatives) between the two groups. The study concluded that recall of informed consent is similar whether consent is obtained immediately or several days before endoscopic procedures. (Elfant AB, Korn C, Mendez L, et al. Dis Colon Rectum 1995 Jan;38(1):1–3).

 
    Lab Update

(Dr. Naveen Dang and Dr Arpan Gandhi)

RDW (Red cell Distribution Width)

The red cell distribution width is a numerical expression which correlates with the degree of anisocytosis (variation in volume of the population of red cells). It can be used

  • To differentiate thalassemia from iron deficiency anemia (this use is not universally accepted)
  • To monitor the results of hematinic therapy for iron–deficiency or megaloblastic anemias; as new, normally–sized cells are produced, the RDW increases at first, but then decreases as the normal cell population gains the majority.
 
ijcpgroup
ijcpgroup
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IJCP
Docconnect
    Medi Finance Update

Balance Funds

The benefit of a balanced fund is that it provides automatic diversification by investing in a variety of asset classes and thereby reduces the risk of one asset class performing poorly. Balanced funds tend to be more risky than bond funds and less risky than equity fund

 
    Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name
Indication
DCI Approval Date
Cinnarizine 20mg + Dimenhydrinate 40mg tablets
For the treatment of vertigo
3–Feb–10
 
    IMSA Update

International Medical Science Academy (IMSA) Update

Pediatric fluid therapy

In a prospective multicentre observational post-authorization safety study, a novel isotonic–balanced electrolyte solution with 1% glucose helped to avoid perioperative acid–base imbalance, hyponatremia, hyperglycemia, and ketoacidosis in infants and toddlers and may therefore enhance patient safety.

(Ref: Sümpelmann R, et al. A novel isotonic–balanced electrolyte solution with 1% glucose for intraoperative fluid therapy in children: results of a prospective multicentre observational post–authorization safety study (PASS). Paediatr Anaesth 2010 Nov;20(11):977–81).

 
    IJCP Special

Dr Good Dr Bad

Situation: A patient of diabetes was on rosiglitazone.
Dr. Bad: Continue to take it.
Dr. Good: Stop it.
Lesson: Due to accumulating evidence of increased cardiac risk, European Medicines agencies including the Drug Controller General of India (DCGI) have suspended the sale of rosiglitazone.

Make Sure

Situation: A patient of asthma worsened on aspirin.
Reaction: Oh My God! Why was history of allergy not taken?
Lesson: Make Sure that patients with asthma are not given aspirin without asking a history of allergy.

 
    Lighter Side of Reading

An Inspirational Story
(By Dr Prabha Sanghi)

Smile and laugh

Laughter, some said it’s the best medicine in the world. So start smiling and laughing as much as you can. Have a hearty laugh over every amusing situation. Laugh even at yourself and smile at the simplest pleasures in your life. With smiles and laughter, your days will become lighter, more joyous and more bearable even on those hay–wired days. Your smiling face looks much more appealing and beautiful too.

Give away your smiles freely and in abundance. Spread your laughter around as it’s contagious. Enjoy these smile and laughter quotes! A smile costs nothing but gives much. It enriches those who receive without making poorer those who give. It takes but a moment, but the memory of it sometimes lasts forever. None is so rich or mighty that he cannot get along without it and none is so poor that he cannot be made rich by it. Yet a smile cannot be bought, begged, borrowed, or stolen, for it is something that is of no value to anyone until it is given away. Some people are too tired to give you a smile. Give them one of yours, as none needs a smile so much as he who has no more to give. A smile is a curve that sets everything straight. Everyone smiles in the same language.

It takes seventeen muscles to smile and forty–three to frown…
Laughter is the shortest distance between two people…
What soap is to the body, laughter is to the soul…
Laughter is a tranquilizer with no side effects…

— — — — — — — — — —

Mind Teaser

Read this…………………

Land Time

Yesterday’s Mind Teaser: "step the rest"
Answer for yesterday’s Mind Teaser:
"A step above the rest"

Correct answers received from: Dr S. Upadhyaya, Dr Rashmi Chhibber, Dr Neelam Nath, Dr Vikas Kumar, Dr Anurag Jain, Dr Vijay Kansal, Dr K Raju, Dr Jainendra Upadhyay, Dr Jainendra Upadhyay, Dr K P Rajalakshmi

Answer for 8th December Mind Teaser: "One step forward, two steps back"
Correct answers received from: Dr Anupam, Dr Prachi 

Send your answer to ijcp12@gmail.com

— — — — — — — — — —

Laugh a While
(Contributed by Dr GM Singh)

Doctor, doctor, I keep thinking I’m a billiard ball.
Get back in the queue.

 
    Readers Responses
  1. Somebody high in the IMA hierarchy told me today that he is soon going to the court on the CEA. If that happens, either under the banner of the IMA or individually, I will feel a bit relieved. This thing has been hanging heavy on my mind. The time is slipping. If the Act is notified, which can happen any day, it will be a bombshell for the medical community. It is better if the legal route is taken before the notification. This will likely prevent/delay notification pending court judgment. I may mention that in August this year, the owner of a big nursing home in the South, a doctor himself, had told me not to worry since he was "very soon" going to challenge the CEA in the court. Apparently he has not done so till now. It is surprising that not a single case has been filed in any court against the CEA so far. What a pity! And, what a sad commentary on doctors, their associations and the medical community in general, including the owners of nursing homes and hospitals. That is why I say that doctors are least concerned about justice and rights. If they think somebody else should help them while they simply sit and cry, then good luck to their crying. I did not coin the proverb –– God helps those who help themselves. M C Gupta
 
    Public Forum

(Press Release for use by the newspapers)

Diabetics should avoid late nights

Young adults who do not get enough deep sleep may be increasing their risk of type 2 diabetes, according to a study published in the Proceedings of the National Academy of Sciences, said Padma Shri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India.

Failing to sleep deeply for just three nights running has the same negative effect on the body’s ability to manage insulin as gaining 20 to 30 pounds. Three nights of interrupted sleep effectively gave people in their 20s the glucose and insulin metabolisms of people three times their age. These findings demonstrate a clear role for slow–wave sleep in maintaining normal glucose control. A profound decrease in slow–wave sleep had an immediate and significant adverse effect on insulin sensitivity and glucose tolerance. Improving the quality of sleep, especially for people as they age or if they are obese, could be an important step in preventing the onset of type 2 diabetes.

The researchers recruited five men and four women, all lean and healthy, who were between the ages of 20 and 31 years. The researchers first observed the participants for two nights of uninterrupted sleep, during which they slept for 8.5 hours, to establish their normal sleep patterns.

They then observed the same participants over a three–night study period, during which the researchers deliberately disturbed their sleep when their brain waves indicated the beginning of slow wave sleep. The sounds used to interrupt the sleep patterns were loud enough to move the participants to a different level of sleep but not loud enough to fully wake them. This decrease in slow–wave sleep resembles the changes in sleep patterns caused by 40 years of aging.

Young adults spend 80 to 100 minutes per night in slow–wave sleep, while people over age 60 generally have less than 20 minutes. At the end of each study, the researchers gave intravenous glucose (a sugar solution) to each subject; they then took blood samples every few minutes to measure the levels of glucose and insulin, the hormone that controls glucose uptake. When the researchers analyzed the data they learned that the participants were almost 25 percent less sensitive to insulin after nights of interrupted sleep. As their insulin sensitivity declined, they needed to make more insulin to process the same amount of glucose.

 
    Classifieds – Situation Vacant

Wanted a Senior Resident in Dept. of Pediatric Gastroenterology, Hepatology & Liver Transplantation at Medanta, The Medicity, Gurgaon, Delhi (NCR). Those interested please contact: Dr. Neelam Mohan (9811043475), or Secretary to Dr. Neelam Mohan – Amit (9818200582).

 
    Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

eMedinewS Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on Sunday, January 9th 2011, 8 AM to 6 PM.
The one day conference will revisit and cover all the new advances in the year 2010. There will also be a web–cast of the event. The eminent speakers will be Padmabhushan Dr Naresh Trehan (cardiac surgery); Padma Shri Dr KK Aggarwal (revisiting 2010); Dr Neelam Mohan (liver transplant); Dr N K Bhatia (transfusion medicine); Dr Ambrish Mithal (diabetes); Dr Anoop Gupta (Male infertility); Dr Kaberi Banerjee (Female infertility) and many more.

There will be no registration fee.
Delegate bags, gifts, certificates, breakfast and lunch will be provided.
Kindly register at www.emedinews.in

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